Shoulder trauma

Specialty: Joint pain
Age group: Adult

Criteria for referral to public hospital service

• First episode of shoulder trauma or dislocation in a patient:
  • where their occupation or job requires working with their hands above shoulder height
  • at risk of further dislocations due to ongoing high-impact activities
  • at risk of instability due to structural pathology
• Acute full thickness cuff tear with functional impairment (including following dislocation)
• Recurrent (more than 1) dislocated shoulder or shoulder instability despite at least 3 months of active treatment that included: rehabilitation/physiotherapy, medications and avoidance of triggering events
• Instability associated with structural pathology in a patient (e.g. superior labral anterior posterior (SLAP) lesion, large Bankart lesion)

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Description of joint affected and onset, nature and duration of symptoms
• If referral relates to injury, detail: date, mechanism, severity, recurrence and evolution of injury
• Findings on physical examination including loss of range of movement and neurological examination
• If recurrent dislocation
  • ease and method of dislocations
  • details of previous medical and non-medical management including the course of treatments and outcome of treatments
• Hand preference and how symptoms are impacting on daily activities including impact on work, study or carer role and level of sleep disturbance
• x-rays of the affected shoulder, instability views: anteroposterior (AP) view of Glenohumeral joint, lateral view, superior-inferior (SI) view and axillary lateral view of the affected shoulder
• Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)

Provide if available

• Ultrasound report (including details of the diagnostic imaging practice)
• MRI scan (including details of the diagnostic imaging practice)
• Statement about the patient’s interest in having surgical treatment if that is a possible intervention
• If the person identifies as an Aboriginal and/or Torres Strait Islander
• If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

There are other statewide referral criteria that include reference to shoulder pain:

• Inflammatory arthritis 
• Non-traumatic shoulder conditions
• Osteoarthritis of the shoulder 

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Vulnerable populations include:

• people from culturally and linguistically diverse backgrounds
• older Australians
• carers of people with chronic conditions
• people experiencing socio-economic disadvantage
• people living in remote, or rural and regional locations
• people with a disability
• people with mental illness
• people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

• First episode of shoulder trauma or dislocation without any of the following risk factors:
  • where the person’s occupation or job requires working with their hands above shoulder height
  • at risk of further dislocations due to ongoing high-impact activities
  • at risk of instability due to structural pathology
• Acute full thickness cuff tear without functional impairment following dislocation
• Recurrent (more than 2) dislocated shoulder or shoulder instability where at least 3 months of active treatment that included: medications, rehabilitation or physiotherapy and avoidance of triggering events has not been trialled.